Mental Health FAQs

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What do I Need to Know to Access Mental Health Care?

Accessing mental health care usually varies from the process
of accessing other medical services.
In fact, most insurance companies contract with a separate company to
coordinate mental health care.

Differences to be aware of include:

Benefits

Benefits listed on your insurance card--- deductibles and
copays—usually apply only to medical services. It is necessary to call the insurance company to determine
if there is mental health care coverage, if preauthorization is required,
whether there are deductible and co-pay requirements and if there is a maximum
number of visits. Depending on the
plan, out-of-network benefits may or may not be included. A deductible requirement would be associated
with this coverage and then a certain percentage of the fee would be reimbursed
following fulfillment of the deductible. HMOs generally do not have
out-of-network coverage.

Preauthorization

Preauthorization for services is generally required from any
company designated by the insurance company to coordinate behavioral health
care. It is the responsibility of
the insured to initiate preauthorization by calling the insurance company prior
to the first visit.
Preauthorization is usually tied to a specific provider; so if for
example, a psychiatrist makes a referral for counseling with a licensed social
worker, another preauthorization will be required. In fact, health care providers working in the same practice
may not be covered under the same insurance plans, making preauthorization
imperative prior to each visit with individual providers.

Billing

Because the billing address on the insurance card may only
pertain to medical services, it is always important to confirm the billing
address for mental health care services.

Depending on the type of mental health care required,
different mental health professionals may be necessary.

Differences to be aware of include:

Psychiatrist: Psychiatrists are medical doctors who have
completed medical school and a residency in psychiatry. They are able to prescribe medications,
assess medical conditions and provide counseling and therapy.

Psychologist: Psychologists have earned a doctorate
degree from graduate school in psychology and have completed post-doctoral
internships in clinical care.
While they do not prescribe medicine, they often provide psychotherapy
and are generally the only mental health professionals licensed to provide
psychological testing.

Psychotherapist: Psychotherapists generally
have a Masters level degree in counseling, psychology or social work and more
than two years of supervised clinical work. They are licensed by the State as a
Clinical Social Worker (LCSW, ACSW), a Licensed Professional Counselor (LPC) or
a Marriage and Family Therapist (LMFT). They provide psychotherapy and counseling services to
individuals, families and groups.

What are the Differences Between Psychiatrists,
Psychologists and Psychotherapists?

Differences to be aware of include:

Psychiatrist- Psychiatrists are medical doctors who
have completed medical school and a residency in psychiatry. They are able to prescribe medications,
assess medical conditions and provide counseling and therapy.

For a referral to a licensed and Board Certified psychiatrist in Georgia, you may want to
contact the Georgia Psychiatric Physicians Association (GPPA) at www.gapsychiatry.org where an email
referral request form is available.

Psychologist- Psychologists have earned a doctorate
from graduate school in psychology and have completed post-doctoral internships
in clinical care. While they do
not prescribe medicine, they often provide psychotherapy and are generally the
only mental health professionals licensed to provide psychological testing.

For a referral to a licensed psychologist in Georgia, you
may want to contact the Georgia Psychological Association which offers a confidential
referral line at 404-634-6272. For
more information regarding psychologists in Georgia, visit the Association’s
website at www.gapsychology.org.

Psychotherapist-
Psychotherapists generally
have a Masters level degree in counseling, psychology or social work and more
than two years of supervised clinical work. They are licensed by the State as a
Clinical Social Worker (LCSW, ACSW), a Licensed Professional Counselor (LPC) or
a Marriage and Family Therapist (LMFT). They provide psychotherapy and counseling services to
individuals, families and groups.

For a referral to a Licensed Professional Counselor, the Licensed
Professional Counselors Association of Georgia offers an on-line directory on
their website at www.lpcaga.org.

For a referral to a Licensed Marriage and Family Therapist,
visit the American Marriage and Family Therapist Association’s on-line referral
service at www.therapistlocator.net.

How do I Have Someone Involuntarily Committed for Mental
Health Treatment?

Involuntary Apprehension and Treatment Proceedings and
Standards

(Statues can be
located at Title 37, Chapter 3, Section 1, et seq of the Georgia Code of Law)

Georgia law permits a court to order mandatory treatment -
either in a hospital or in a community center - if a person poses a danger to
himself or others.

In order to have someone detained for a mental health
evaluation/treatment, one of the following is necessary:

Have the person evaluated by a physician, a psychologist,
clinical social worker or a psychiatric clinical nurse who can execute a
certificate of detainment. The
person will then be transported by an officer of the peace to the appropriate
mental health facility.

Or

File an application with the community mental health center
for a court ordered evaluation of the person. Upon determination of the need
for detainment, the community mental health center will petition the
court. The person can then be
brought by an officer of the peace to the appropriate facility.

Or

File a petition with the Probate Court*. This requires
having two family members or other persons familiar with the person and their
behavior present. The judge will make a determination and have an Order To
Apprehend issued which will result in the person being taken by a peace officer
to the appropriate mental health facility.

Or

Call the Police/ Sheriff* who can take the person to be
evaluated by a physician or who can make a determination of need for
involuntary treatment and transport the person to the appropriate mental health
facility. This option should only be used as a last resort, because it puts the
ill person in confrontation with armed officers who may not understand the
nature of the illness.

Before a person can be delivered to an emergency receiving
facility for an examination or evaluation by appropriate medical professionals
as to any need for involuntary treatment, the observed facts must meet the
following standards:

Inpatient Treatment Standards

The person is a mentally ill person, a drug dependent
individual or an alcoholic requiring involuntary treatment (i.e. who refuses
treatment); and

who presents a substantial risk of imminent harm to himself
or others as manifested by either recent overt acts or recent expressed threats
of violence which present a probability of physical injury to himself or to
other persons; or

who is so unable to care for his or her own physical health
and safety as to create an imminently life-endangering crisis.

Outpatient Treatment Standards

The person is a mentally ill person, drug dependent
individual or alcoholic requiring involuntary treatment (i.e. who refuses
treatment); and

who is not an inpatient but who, based on the person's
treatment history or current mental status, will require outpatient treatment
in order to avoid predictably and imminently becoming an inpatient; and

who because of the person's current mental status, mental
history, or nature of the person's mental illness is unable voluntarily to seek
or comply with outpatient treatment.

How do I Apply for Social Security Disability?

Disability under Social Security is based on your inability
to work. You will be considered disabled if you cannot do the work you did for
at least one year from the time of your illness/ disability. Social Security Disability Insurance
(SSDI) pays benefits to you and certain members of your family if you are
"insured" meaning that
you worked long enough and paid Social Security taxes. Supplemental
Security Income (SSI) pays benefits based on financial need to low
income disabled persons who have not worked enough to be eligible for SSDI. SSDI includes Medicare coverage after
two years. SSI provides Medicaid
insurance, which includes a prescription drug plan. Prescription coverage is in
the works for Medicare, but may be limited by the use of formularies and
fail-first policies regarding access to certain medications.

In order to apply for Social Security benefits you must
provide certain documents including:

the Social Security number and proof of age for each person
applying for payments including your spouse and children, if they are applying
for benefits;

names, addresses and phone numbers of doctors, hospitals,
clinics and institutions that treated you and dates of treatment;

names of all medications you are taking;

laboratory and test results;

a summary of where you worked and the kind of work you did
(i.e. work history)

a copy of your W-2 Form (Wage and Tax Statement), or, if you
are self-employed, your federal tax return for the past year; and

dates of prior marriages if your spouse is applying.

How do I Initiate an Individualized Education Plan (IEP) for
my Child?

An Individualized Education Program (IEP) is an education
plan for a child with a disability who is eligible for special education and
related services under the IDEA.
The plan is developed, reviewed, and revised by a specialized team made
up of school personnel and parents/guardian.

Step 1. Child is identified as possibly needing special
education and related services --either by the school or the parent.

Step 2. Child is evaluated. Testing will be provided by the school system during regular
school hours. If the parents disagree with the evaluation performed by the
school system, they have the right to take their child for an Independent
Educational Evaluation (IEE). They can ask that the school system pay for this
IEE.

Step 3. Eligibility is decided. Under the law, parents may ask for a hearing to challenge the
eligibility decision if they disagree.

Step 4. Child is found eligible for services. Within 30 calendar days after a child
is determined eligible, the IEP team must meet to write an IEP for the child.

Step 5. IEP meeting is held and IEP is written. Parents and the student (when
appropriate) are participants in this meeting. The parents also have the right
to invite to the meeting any persons having knowledge or expertise about their
child (e.g. therapist).

Step 9. IEP is reviewed. The child’s IEP is reviewed by the IEP team at least once a
year, or more often if the parents or school ask for a review. If necessary,
the IEP is revised. Parents, as team members, must be invited to attend these
meetings. Parents can make suggestions for changes, can agree or disagree with the
IEP goals, and agree or disagree with the placement. They may also file a complaint with the state education
agency.

Step 10. Child is reevaluated. At least every three years the child
must be reevaluated. This evaluation is often called a "triennial."
Its purpose is to find out if the child continues to be a "child with a
disability," as defined by IDEA, and what the child’s educational needs
are. However, the child must be reevaluated more often if conditions warrant or
if the child’s parent or teacher asks for a new evaluation.

*At any time during the process, dissatisfied parents may
file a complaint with the state education agency www.ed.gov

How do I Obtain a Medicaid Waiver?

A Medicaid waiver is a long-term care program that allows the
individual to receive services at home or in the community that would normally
only be Medicaid-covered in an institution. A waiver can allow for various
services such as (but not limited to): Day habilitation services, Residential
training and supervision, Home Health, Respite Care, Personal Support Services,
Home modifications, Supported Employment, Emergency Response, Vehicle
Adaptation.

In the state of Georgia, there are several waivers that
cover the mentally disabled, currently the Mental Retardation Waiver Program
serves the most individuals. The Mental Retardation Waiver Program (MRWP)
states that all candidates must be deemed appropriate for nursing
home/institutional care by a physician and the Georgia Medical Care Foundation. Consideration for the Mental
Retardation Waiver is extended to Medicaid eligible mentally retarded and
developmentally disabled individuals who are not currently receiving Medicaid
benefits under a cash assistance program.

To obtain a Medicaid Waiver, one must first contact the
Intake and Evaluation Office/Agency assigned to their region (You may find out
the contact number of the office by visiting www.thegao.org
or calling 800-537-2329). The individual must then obtain an application from
the office. The application must be completely filled out and then submitted
via fax, mail, or in person. Once the application is received, the office will
set a screening appointment, at which time the individual must have present:

(1) copies of any previous evaluations by a doctor,
psychologist, school(s) attended, or any other document containing information
regarding the skills and abilities of that individual, (2) addresses for
doctor, psychologist, school, or any other source providing an evaluation, (3)
copies of Medicaid, Medicare and/or insurance information,

(4) copies of the individual’s tax return from last year, a
recent pay stub, or social security benefit information. If the individual
needing the service is under 18, it is required that information about the
family’s income must be presented.

The individual will be notified IN WRITING about the
preliminary eligibility determination within seven working days after the
screening appointment.

How to Obtain Mental Health Services if You or Your Child is
on Medicaid

Beginning in June 2006 persons enrolled in Medicaid and
Peachcare will be automatically enrolled in Georgia Healthy Families and served by one
of three managed care companies (CMOs).

What this means is that providers [doctors & hospitals]
who used to be covered by your Medicaid plan, may no longer be covered under
the new plan.

Please be aware:

Doctors and hospitals are not necessarily contracted with all
three of the CMOs, so it is always necessary to determine whether a provider or
facility is covered prior to making an appointment.

Scheduled appointments are required for all non-emergency
visits in order to get CMO preauthorization (permission).

To find information regarding providers enrolled with your
Care Management Organization (CMO), you may contact the CMO by phone or visit
their website for a provider directory.

Georgia Care Management Organization Contact Information

AMERIGROUP

P.O. Box 62509 East/ North Region

Virginia Beach, VA 23466-9933

1-888-821-1108

www.amerigroupcorp.com/georgia/

WellCare

1-800-546-6814

www.wellcare.com/HealthPlans/Georgia/

WellCare/Medicaid.aspx

Peach State Health Plan

3200 Highlands Parkway SE, Suite 300

Smyrna, GA 30082 1-866-874-0633

www.pshpgeorgia.com

Exceptions: Some members are excluded from joining (do not
need to join) a health plan and will continue to be served by their current
plan. These exceptions include:

People who need special medical services or live in an
institution

People in Medicaid who qualify for Medicare

People in Medicaid who are part of an Indian Tribe that the
government approves

People who qualify for Supplemental Security Income (SSI)

Children eighteen (18) years of age or younger who are in
foster care or another

out-of-state home

Children (18) years of age or younger who are getting foster
care or adoption assistance under Title IV-E of the Social Security
Administration

Children in the Children’s Medical Services Program

Children in the Georgia Pediatric Program

Children with care coordination by the MATCH program
(Multi-Agency Team for Children)

People in Long Term Care

People in the SOURCE program (Service Options Using
Resources in Community

Environments)

People in Pre-Admission Screening and Resident Review

People who are getting Hospice care

For more information on the new program or to enroll,
contact Georgia Healthy Families at 1-888-423-6765 or visit www.gahealthyfamilies.com

How to Apply for Medication Subsidies

Finding financial assistance in order to obtain medication
can be confusing. Listed
below are several websites which can help:

Partnership for Prescription Assistance www.pparx.org offers a single point of access
to more than 275 public and private patient assistance programs, including more
than 150 programs offered by pharmaceutical companies. It identifies patient
assistance programs for which patients may be eligible based on demographic and
financial qualifications and provides downloadable patient applications.

Needy Meds www.needymed.com Provides a detailed listing of
local, state and manufacturer-sponsored patient assistance programs, including
contact and application instructions.

Together Rx Prescription Savings Program
1-(800)-444-4106
www.togetherrxaccess.com
The Together Rx Access™ is a free drug card program that offers 25% to 40%
savings on prescriptions for over
275 brand-name drugs for qualified, low-income Americans who are not eligible
for Medicare and have no prescription drug insurance.

Please note that all pharmaceutical companies do not offer
patient assistance programs and of those which do, assistance may not be
offered for all of their medications.

Listed below are some of the more common psychiatric
medications for which patient assistance is offered by the manufacturer, along
with contact information.

Zyprexa Lilly (Lilly Cares)
1-(800)-545-6962
www.lillycares.com

How do Create a Wellness Recovery Action Plan?

A WRAP is a written record that allows a person with a
mental illness to identify their symptoms, track them daily, and make a plan
for treatment in the eventuality that it becomes necessary. A WRAP allows the person with a mental
illness to communicate their wishes regarding treatment to others, even when
they are incapacitated by symptoms.
The key factor is that the WRAP is developed during a period that a
person feels relatively in control of their symptoms, and it is then
distributed to their supporters and updated as needed.

It is not difficult to make a WRAP, but it is especially useful
if the person creating it has specific wishes regarding the choice of treatment
facilities, doctors, or methods of treatment that are acceptable.